Rape

September 26, 2011

The Latin word “to steal or carry off” is rapere and described the behavior of ancient Romans who stole their wives from other tribes. Laws delivered by Moses in Deuteronomy 22:22-28 categorized rape and what occurred to victims and perpetrators. The tragedy of rape continues today of children, adolescents, and adults, including the very elderly. The frequency rises so dramatically during wartime that even collecting firewood or bringing water to one’s family carries incredible risk.

Female victims are more frequent than males by a ratio of 13.5:1 in the United States with the highest prevalence (5/1,000) in male and female adolescents between 16 and 19 years old. It is estimated in this country that more than 25% of women at some point in their lives will experience nonconsensual sexual penetration of their anus, vagina, or mouth.

Sexual assault includes multiple types of inappropriate or forced sexual behaviors. Under this heading, there is molestation or noncoital activity between an adult and a child as well as various types of rape, forced sexual intercourse. Statutory rape exists when an adult (over 18 years of age) sexually penetrates a child or adolescent. Gang rape involves one victim with multiple perpetrators. Date or acquaintance rape exists when the perpetrator is known. Two thirds to three quarters of adolescent rapes are perpetrated by an acquaintance or family member.

Adolescent victims are more likely than adults to have used alcohol or drugs, but less likely to have been physically injured. Adolescents and young adults are at higher risk for receiving the date rape drug flunitrazepam (Rohypnol), which is profoundly sedating for up to 12 hr.
The risk of developing a sexually transmitted disease (STD) varies with region of the country, age, and sex among other factors. Syphilis, gonorrhea, HIV, herpes, papillomavirus, chlamydia, candida, and gard-nerella are reported. The Centers for Disease Control and Prevention updates guidelines regularly for prophylaxis of STDs within the first 72 hr and recommendations to monitor the development of STD-related symptoms—initially for all STDs and again at 6 months for HIV.

A needed history and physical examination is frequently quite difficult. The victim, who has already been terrorized, often does not want to relive the account in her mind and can feel violated by a physical examination. Ideally a police officer, physician, nurse, and rape crisis volunteer who are well trained in rape intervention will be on hand. Emotional support is provided with careful explanation of why particular questions are asked, why an intimate detailed physical examination is necessary, or why photos are taken and specimens properly collected. This is not easy under any circumstances, but especially when the victim is a younger child, is disabled and suffering from contrac-tures, or elderly with dementia.

There are multiple reasons for rape, but sexual tension is not high on the list. Most rapists live with a sexual partner and prostitution is also available. Power through violence is misidentified as healthy male aggression or animal instinct gone awry. Although society’s desire to reestablish the family is sound, promoting an individual’s “license to abuse” is not. When some males perceive their patriarchal rule threatened, they rationalize violence to assure female subordination. These men may have difficulty communicating to women in any other manner. Poor interpersonal skills and a sense of insecurity lead to attacks that humiliate and degrade women. Some are merely angry while others are sadistic. Up to 40% of rapes are meant as punishment and 5% are only satisfied by torture or murder.

A psychological interpretation is that many rapists were abused as children and grow up with low self-esteem, resentment, and hostility. Impulsive behavior and poor ego structure lead some to acknowledge a likelihood to commit rape if they can escape punishment.

The motivation to rape during times of war includes revenge, genocide, and ethnic cleansing. Women and girls living in refugee camps or left in their homes when husbands and sons are off to war are at great risk for rape, STDs, and pregnancy. Women may also be forced into sexual acts to gain passage for themselves and their families at a border crossing. Not only do they experience posttraumatic stress disorder and depression, but also they may be rejected by their clan and sent away if they become pregnant after the rape. These acts are directed at humiliation of the males who are off fighting and are unable to protect their women. A woman and her family may feel tremendous disgrace if she becomes pregnant after this act of violence. The babies are at high risk for neglect, abandonment, or infanticide. It is no wonder that women who have been molested are frequently afraid to let anyone know what has occurred. Feeling powerless and fearful of retaliation, they may not seek medical help for prophylaxis of infection or reconstructive surgery for injuries.

The tragedy of rape is clearly not often punished during war despite efforts of some humanitarians to address these wrongs. However, even in this country where there is relative peace, only 9.5% report non-marital attempted rapes or 6% of those who survive rape. Many drop the charges before committal if interrogators imply by questioning that the woman may have encouraged it in some way. Many perpetrators negotiate for a lesser offense. Only 10% of the 6-9.5% who report (0.6-0.95% of all cases) will actually see conviction of the perpetrator. There is much to be done to improve the compassion and care for victims of abuse, as well as provision of education about prevention and procurement of treatment and legal protection.